Weekday Registration/Freedom Aquatic Center 2010-2011

(to print, right-click this page and select print)
   
Please make checks payable to: Riptide Swim Team
 
Mail registration form and payment to:
Shandra Richardson
6712 Jackpin Place
Gainesville, VA  20155

 

 

FAMILY NAME

LAST NAME FIRST NAME
STREET CITY STATE ZIP
HOME PHONE FATHER WORK MOTHER WORK
FATHER CELLULAR MOTHER CELLULAR FAMILY EMAIL
EMERGENCY CONTACT EMERGENCY PHONE

SWIMMERS

LAST NAME SUMMER CLUB
FIRST NAME & MIDDLE INT. FOR EACH SWIMMER
1 2 3 4
DOB SEX AGE
DOB SEX AGE
DOB SEX AGE
DOB SEX AGE
50yd freestyle time:

100yd IM time:

 50yd freestyle time:

100yd IM time:

 50yd freestyle time:

100yd IM time:

 50yd freestyle time:

100yd IM time:
T-Shirt Size: T-Shirt Size: T-Shirt Size: T-Shirt Size:
WORKOUT DAYS & TIME: WORKOUT DAYS & TIME: WORKOUT DAYS & TIME: WORKOUT DAYS & TIME:

PAYMENT:  Additional swimmers receive 10% discount ($430 1 x a week, $775 2 x's a week, $1,150 3 x's a week

TOTAL AMOUNT FOR SWIMMER 1 TOTAL AMOUNT FOR SWIMMER 2 TOTAL AMOUNT FOR SWIMMER 3 TOTAL AMOUNT FOR SWIMMER 4

Payment Contract: Upon acceptance into any of the Riptide Swim Team programs, both my swimmer(s) and I agree to abide by all team rules. I understand that I am obligated to pay the full program fees as indicated.  I understand my child will be prohibited from taking part in any team practice, meet, or activity if I fail to make payments in a timely manner. 

TOTAL AMOUNT FOR FAMILY $ __________._____

$75.00 (no meets) or $245 (with meets) non-refundable registration fee per swimmer due upon Registration (not part of total fee).

50% of fees due October 1st, 2010

100% of fees due March 1, 2011
   
X_____________________________________________________________________________________
Parent/Adult Signature Date